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Peripheral Arterial Disease template

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Description of Peripheral Arterial Disease (PAD)A systemic disease which leads to impedance of arterial blood flow to the lower extremities. They upper extremities can be involved, but this is not usual
Risk Factors for PADAdvancing age Elevated serum lipids Hypertension Cigarette Smoking Diabetes Mellitus Obesity Family Hx
Assessment Findings in PADIntermittent Claudication (earliest manifestation) Pain, ache, cramp, or tired feeling in extremity, foot, hip, thigh, or buttocks with exercise Lack of hair growth on lower legs Thickened toenails Pain at rest (severe disease) Diminished or absent pulse distal to the lesion Bruits in abdominal, femoral, or popliteal areas Pale, cool extremities Shiny, hairless skin Dependent rubor (severe disease) Prolonged cap refill
Diagnostic Studies for PADDoppler and US Segmental BP measurements; expect reduction in pressure Ankle-brachial Index: </= 0.9 indicative of disease Arteriography
Nonpharmacologic Management of PADExercise (stop when hurts but restart when relieved) Prophylactic foot care Percutaneous transluminal angioplasty Bypass Surgery Pt Education
Pharmacologic Management of PADAnti-Platelets Blood Viscosity Reducer
Anti-Platelets in PADInhibit platelet aggregation and produce mild vasodilation Monitor for hypotension, bleeding Antiplatelet therapy used to prevent ischemic events Interacts with grapefruit juice
Blood Viscosity Reducers in PADMechanism unclear but thought to reduce blood viscosity Monitor for bleeding and hypotention
Special Considerations for Management of PADUse both anti-platelet and blood viscosity reducer to prevent claudication AVOID Beta Blockers: May worsen claudication Nitrates have not proven helpful
Consultation/Referral for PADRefer to Vascualr surgeon for persistent symptoms or moderate to severe ischemia Refer if exercise and meds have not helped in 3-6 months Refer non-healing ulcers
Follow-Up for PADAs dictated by pt condition

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